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8.coverUnless you have been hiding away from all published materials you will be aware that Monash University in Australia have proposed and others have supported that for people with irritable bowel syndrome, that following a diet low in FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols content will result in symptom resolution.

Yet here at Clinical Education we have stressed that following this diet has risks of key nutrient insufficiencies and in particular those foods rich in aryl hydrocarbon receptor agonists, which are vital for gut mucosal immune balance and competence. In effect the use of a low FODMAP diet for long term health is not justified, but short term intervention may be helpful.

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ajg_cimageA paper in the American Journal of Gastroenterology looks at various markers to see if it is possible to use them to differentiate between IBS and IBD.[1]

Objectives:

Irritable bowel syndrome (IBS) is viewed as a diagnosis of exclusion by most providers. The aim of our study was to perform a systematic review and meta-analysis to evaluate the utility of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), faecal calprotectin, and faecal lactoferrin to distinguish between patients with IBS and inflammatory bowel disease (IBD) and healthy controls (HCs).

The remedies for gastrointestinal complaints are legion and stretch back far in human history. Ancient Chinese physicians prescribed anise for flatulence, while Dioscorides, chief physician for the Roman army, recommended garlic for parasites. Many are effective and stand the test of time, but contemporary scientific research on novel extracts offers up surprising new finds. The Asian plant, Perilla (Perilla frutescens) for example, offers valuable assistance in the management of functional gut problems.

A study published in the BMC Complementary and Alternative Medicine Journal identifies a number of benefits and improved function, achieved in people with IBS ( a functional loss of tolerance in the GI Tract) when consuming a 300mg daily dose of Perilla Extract.[1]

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Conclusions Patients complaining of flatulence have a poor tolerance of intestinal gas, which is associated with instability of the microbial ecosystem.[1]

Significance of this study

What is already known on this subject?

  • Some patients specifically complain of excessive evacuation of gas per anus.
  • Intestinal gas content depends by-and-large on gas production by bacterial fermentation of unabsorbed substrates.
  • Diet influences anal gas evacuation and gut microbial composition.
  • A proportion of patients complaining of flatulence have increased number of gas evacuations, but the net volume of gas evacuated is within the normal range.
  • Flatulence is associated with abdominal symptoms.

The use of faecal transplantation as a therapeutic tool for not only Clostridium Difficile Infection but as a mechanism for changing the composition of colonic microbiota for the purpose of resolving numerous persistent inflammatory conditions is starting to gain increased interest in the research and medical communities.

Medscape recently published a summary of many of the key areas and I have extracted and edited a small section for peoples review.

Faecal Transplant (FT) and IBD

Tuesday, 25 September 2012 by | Comments: 2

I have explored the role of appropriate transplantation in the resolution of MRSA infection that fails to resolve with antibiotic therapy, and have intimated that other conditions of the bowel and linked tissues may also benefit. The model is: that loss of mucosal tolerance underlies the pathology of inflammatory bowel disease and is also linked to irritable bowel syndrome. These altered states of function reflect a combination of environmental, genetic and emotional events that coalesce into a wide range of conditions.

Giardia lamblia (synonymous with Giardia intestinalis, Lamblia intestinalis and Giardia duodenalis) is a flagellated protozoan parasite that colonises and reproduces in the small intestine, causing giardiasis. The giardia parasite attaches to the epithelium by a ventral adhesive disc, and reproduces via binary fission. Giardiasis does not spread via the bloodstream, nor does it spread to other parts of the gastro-intestinal tract, but remains confined to the lumen of the small intestine.

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IBS And Food – Is There A Link?

Wednesday, 02 November 2011 by

There is a growing body of evidence to suggest that certain dietary constituents exacerbate symptoms and perhaps contribute to the pathogenesis of IBS. Patients have long associated their IBS symptoms with the ingestion of certain foods, combinations of foods, or generally with meals. Response rates from elimination diets have ranged from 15%-71%,[1] with wheat, milk, and eggs being the most commonly implicated foods.

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It will be of no real surprise to know that the incidence of irritable bowel syndrome (IBS) is common. Around the world it is estimated that some 10-20% of the population suffer from it. This is not an inconsequential number, and apart from the miserable statistics, it comes with loss of function, misery, anxiety, pain, bloating, altered bowel habits and loss of quality of life.

Whilst a clear explanation of the cause remains somewhat elusive, there is an increasing acceptance that the relationship between the brain-gut axis, central nervous system, peripheral stress response, infection, dysbiosis, barrier defects, inflammation and immune imbalance play significant roles in the causation.

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